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Kasting ML, Christy SM, Sutton SK, Lake P, Malo TL, Roetzheim RG, Schechtman T, Zimet GD, Walkosz BJ, Salmon D, Kahn JA, Giuliano AR, Vadaparampil ST. Florida physicians' reported use of AFIX-based strategies for human papillomavirus vaccination. Prev Med 2018; 116:143-149. [PMID: 30219689 PMCID: PMC6260815 DOI: 10.1016/j.ypmed.2018.09.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Revised: 07/27/2018] [Accepted: 09/11/2018] [Indexed: 11/24/2022]
Abstract
HPV vaccination rates in Florida are low. To increase rates, the CDC recommends clinics adhere to components of their evidence-based quality improvement program, AFIX (Assessment, Feedback, Incentives, and eXchange of information). We explored factors associated with engaging in HPV-specific AFIX-related activities. In 2016, we conducted a cross-sectional survey of a representative sample of 770 pediatric and family medicine physicians in Florida and assessed vaccination practices, clinic characteristics, and HPV-related knowledge. Data were analyzed in 2017. The primary outcome was whether physicians' clinics engaged in ≥1 AFIX activity. We stratified by physician specialty and developed multivariable models using a backward selection approach. Of the participants in the analytic sample (n = 340), 52% were male, 60% were White of any ethnicity, and 55% were non-Hispanic. Pediatricians and family medicine physicians differed on: years practicing medicine (p < 0.001), HPV-related knowledge (p < 0.001), and VFC provider status (p < 0.001), among others. Only 39% of physicians reported engaging in ≥1 AFIX activity. In the stratified multivariable model for pediatricians, AFIX activity was significantly associated with HPV-related knowledge (aOR = 1.33;95%CI = 1.08-1.63) and provider use of vaccine reminder prompts (aOR = 3.61;95%CI = 1.02-12.77). For family medicine physicians, HPV-related knowledge was significant (aOR = 1.57;95%CI = 1.20-2.05) as was majority race of patient population (non-Hispanic White vs. Other: aOR = 3.02;95%CI = 1.08-8.43), daily patient load (<20 vs. 20-24: aOR = 9.05;95%CI = 2.72-30.10), and vaccine administration to male patients (aOR = 2.98;95%CI = 1.11-8.02). Fewer than half of Florida pediatric and family medicine physicians engaged in any AFIX activities. Future interventions to increase AFIX engagement should focus on implementing and evaluating AFIX activities in groups identified as having low engagement in AFIX activities.
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Affiliation(s)
- Monica L Kasting
- Moffitt Cancer Center & Research Institute, Division of Population Science, 12902 Magnolia Drive, MRC-CANCONT, Tampa, FL 33612, United States; Moffitt Cancer Center & Research Institute, Center for Immunization and Infection Research in Cancer, 12902 Magnolia Drive, Tampa, FL 33612, United States.
| | - Shannon M Christy
- Moffitt Cancer Center & Research Institute, Division of Population Science, 12902 Magnolia Drive, MRC-CANCONT, Tampa, FL 33612, United States; University of Tennessee Health Science Center, College of Medicine, 66. N. Pauline St., Suite 322, Memphis, TN 38163, United States; University of South Florida, Morsani College of Medicine, 13330 USF Laurel Drive, Tampa, FL 33612, United States.
| | - Steven K Sutton
- University of South Florida, Morsani College of Medicine, 13330 USF Laurel Drive, Tampa, FL 33612, United States; Moffitt Cancer Center & Research Institute, Division of Quantitative Sciences, 12902 Magnolia Drive, MRC-CANCONT, Tampa, FL 33612, United States.
| | - Paige Lake
- Moffitt Cancer Center & Research Institute, Division of Population Science, 12902 Magnolia Drive, MRC-CANCONT, Tampa, FL 33612, United States.
| | - Teri L Malo
- University of North Carolina, Lineberger Comprehensive Cancer Center, 101 East Weaver Street, Ste 203, Campus Box 7293, Carrboro, NC 27510, United States.
| | - Richard G Roetzheim
- Moffitt Cancer Center & Research Institute, Division of Population Science, 12902 Magnolia Drive, MRC-CANCONT, Tampa, FL 33612, United States; University of South Florida, Morsani College of Medicine, 13330 USF Laurel Drive, Tampa, FL 33612, United States.
| | - Tommy Schechtman
- Pediatric Partners, 3401 PGA Blvd, Suite 300, Palm Beach Gardens, FL 33410, United States.
| | - Gregory D Zimet
- Indiana University School of Medicine, Department of Pediatrics, 410 W. 10th Street, HS 1001, Indianapolis, IN 46202, United States.
| | - Barbara J Walkosz
- Klein Buendel, Inc., 1667 Cole Blvd. Ste. 225, Golden, CO 80401, United States.
| | - Daniel Salmon
- Johns Hopkins University, Bloomberg School of Public Health, 615 N. Wolfe Street Room W5035, Baltimore, MD 21205, United States.
| | - Jessica A Kahn
- Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue MLC 4000, Cincinnati, OH 45229, United States; University of Cincinnati, College of Medicine, 3230 Eden Avenue, Cincinnati, OH 45267, United States.
| | - Anna R Giuliano
- Moffitt Cancer Center & Research Institute, Division of Population Science, 12902 Magnolia Drive, MRC-CANCONT, Tampa, FL 33612, United States; Moffitt Cancer Center & Research Institute, Center for Immunization and Infection Research in Cancer, 12902 Magnolia Drive, Tampa, FL 33612, United States.
| | - Susan T Vadaparampil
- Moffitt Cancer Center & Research Institute, Division of Population Science, 12902 Magnolia Drive, MRC-CANCONT, Tampa, FL 33612, United States; Moffitt Cancer Center & Research Institute, Center for Immunization and Infection Research in Cancer, 12902 Magnolia Drive, Tampa, FL 33612, United States; University of South Florida, Morsani College of Medicine, 13330 USF Laurel Drive, Tampa, FL 33612, United States.
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